Hair Restoration Blog

Hair restoration cost is one of the main questions that is on the mind of most people who want to go through the process of hair transplantation. There is a wide range when it comes to the cost for hair restoration surgery nationwide.

The cost of hair restoration has never been better considering the quality of hair restoration surgery that could be offered these days. When you shop around for hair transplant surgery, you have to be aware that it’s not like shopping for a car or a shampoo that could be found with the same quality in different location. There is also a wide range for the quality of service that you receive.

Hair transplant has been evolving the last 10 years. Some hair restoration centers kept on with the new techniques and technology, but many stopped at some point in between.  I still see patients who received micrograft surgery one to two years ago in a hair transplant clinic in Beverly Hills. That is not all and you may see procedures done without proper attention to the patient’s facial aesthetics. Missing some of the details in the process may make the results disastrous. Little changes in direction and distribution of transplanted hair may be the difference between a happy camper and an unsatisfied client.

Aside from the artistic aspects of a hair transplant, preparation and maintenance of the grafts are very crucial and are not to be taken lightly, which is another cause of poor growth.

Having said that, getting a hair transplant by an artistic hair restoration surgeon could be done affordably these days. Medical hair restoration cost has been at the lowest since the birth of hair transplant surgery. Due to the current economy, many hair restoration centers have special packages and promotions that wouldn’t be available in a more stable economy. We at US Hair Restoration have our special promotion: 20% discount on standby rate and we also give 0% financing for two years or low interest financing for five to six years.

Cost of hair restoration being so little is a good excuse for many people to take advantage of the situation and get their hair restoration surgery done with significant discount. There is a big warning, though. When it comes to hair restoration cost, you have to understand that this is a customer beware market.

We are giving 20% off our high quality state-of-the-art hair transplant surgery costs. That brings the rate down to $3.2/grafts from our original cost ($4/graft). Still you can find hair restoration centers that offer cheap hair transplant surgery at $2/graft, but you are not comparing apples to apples.

You are getting a procedure with permanent effect on your face and your life. You do not want to take this lightly. If a center used the best standard in their surgeries and the most qualified personnel, they still cannot go lower than a certain price or it won’t be profitable for them. So beware of huge discounts and unreasonably low rates. Go meet the doctor or several of them. Educate yourself and ask proper questions about the technique and services being provided.

Never do cost shopping when it comes to cosmetic surgery. There are many hair restoration centers that offer cheap hair restoration. Remember, there is one thing about hair restoration surgery that can be both good and bad: the result is permanent, good or bad!

Q:

Hi Doctor,

My mother is obsessed with my hair loss and gives me a whole bunch of vitamins and mineral tablets everyday to help regrow my hair.
Do you think they work? Or should I stop them.

A:

Although lack of certain vitamins and minerals could cause hair loss in their sever form, living in north America and having a normal and balanced diet; it is unlikely that you are suffering from vitamin or mineral deficiency. On the contrary, if you look at your family pattern of hair loss, you probably can find other male members of the family who has similar male pattern hair loss. As I always say, you need to have the triangle of baldness, which is “Gene, Male gender, and time” to become bald. Vitamins deficiency is not to blame as part of triangle of male patterned hair loss. You can continue taking vitamins to please your mom, but don’t overdo it since vitamins are not going to bring your hair back. Instead you need to see a good hair specialist or dermatologist and undergo a good hair loss evaluation with miniaturization study and start taking one of the effective medications to prevent further hair loss or to use hair transplant to restore your lost hair.

Q:

I have heard high estrogen in males can contribute to hair loss. Is that true? I am a 40 year old man with low sex drive and female patterned hair loss.

A:

High levels of estrogen in men could be seen in many other conditions such as estrogen-producing tumors, congenital adrenal hyperplasia, chronic alcoholism and advanced liver disorders. Elevation of estrogen in men can cause sexual dysfunction, change in body fat distribution in a female pattern and breast enlargement and secretion.

Balding is not a typical sign of excess estrogen. In fact one of the signs of estrogen deficiency could be hair loss in female patients. A common type of this kind of hair loss is seen in telogen effluvium that women lose hair due to sudden drop of estrogen and progesterone levels. Although excess estrogen is generally not the trigger for hair loss, it can affect the balance of other hormones and indirectly cause hair loss. The latter is not a common cause of hair loss in men or women though.

Q:

How are you doing? All I have to say is TGIF.

I was doing a little bit research on hair loss, and I stumbled over retinoic acid. I read about it and have a basic understanding. Have you heard any claims that it could possible revive hair loss?

Have a great weekend!

A:

This is a good question. There are several claims on therapeutic effect of all-trans-retinoic acid (tretinoin) alone and in combination with 0.5% minoxidil for hair loss based on limited studies.

In one study the combination of tretinoin and minoxidil was used for 56 patients who had androgenic alopecia (male pattern baldness) and hair growth was followed. The growth of terminal hair was studied after one year of treating balding scalp with combination of topical tretinoin with 0.5% minoxidil. Increase in hair growth was reported in 58% of the patients who could complete the study.

Although tretinoin has been stated as a promoter of cell proliferation and vascular creation, which are both important in hair growth, there is still not enough scientific evidence from large studies to prove these effects. Also double blind studies on the efficiency and adverse effects of the product is lacking.

Cicatricial alopecia refers to a group of rare skin diseases in which hair follicle get destroyed and replaced by scar tissue. It is one of the rare causes of hair loss. Hair loss could be gradual or sudden. Hair loss could be without any symptoms or it could present with sever itching, burning and pain. There is usually no visible scar, because the inflammation is below the level of skin. Cicatricial alopecia could occur in otherwise healthy men and women of all ages.

Cicatricial alopecias could be primary or secondary. This discussion is confined to the primary cicatricial alopecias in which the hair follicle is the target of the destructive inflammatory process. In secondary cicatricial alopecias, a non-follicle-directed process or external injury, such as severe infections, burns, radiation, or tumors could cause destruction of the hair follicle.

The causes of the cicatricial alopecias are not completely known. However, all cicatricial alopecias involve inflammation directed at the hair follicle, the upper part of the follicle where the stem cells and sebaceous gland are located are generally involved. Permanent hair loss occurs when the stem cells and the sebaceous glands are destroyed. This type of hair loss is usually irreversible.

Cicatricial alopecias can affect both men and women. The majority of patients with cicatricial alopecia have no family history of a similar condition. Central centrifugal cicatricial alopecia is a type of cicatricial alopecia that is more prevalent among black woman. Frontal fibrosing alopecia on the other hand is seen most commonly in post-menopausal women and could be seen in association with chronic skin conditions such as lupus erythematosus and in people with personal or family history of autoimmune disorder. A scalp biopsy is necessary for diagnosis of cicatricial alopecia. Presence of inflammatory cells and scarring could be diagnostic and essential for determining the type of treatment.

Treatment of the lymphocytic group of cicatricial alopecias involves use of anti-inflammatory medications such as steroids, cyclosporine, hydroxychloroquine. When hair follicle destroyed, hair will not grow back. However in some cases using minoxidil solution can help to stimulate growth of some of the remaining hair.

Hair transplant could only be used in the patients who have normal healthy hair on donor area without any microscopic or macroscopic evidence of cicatricial alopeica activity.  If hair multiplication becomes a reality it might potentially be a good option for patients who lost their scalp hair extensively as result of cicatricial alopecia.

I just received the last issue of the Hair Transplant Forum International, the Journal of International Society of Hair Restoration Surgery (ISHRS). Our article, Psychology of Hair Transplant‚ is published as the cover article on this issue of the journal. I also have a copy of the article in our hair loss library in our website. Here is the abstract:

Psychology of Hair Transplant

Parsa Mohebi, M.D., William Rassman, M.D.

Balding and its psychological impacts has been the subject of many studies in the past. The relationship between hair loss and stress is clear to all clinicians who practice in this field. Negative psychosocial impacts of hair loss in male patterned baldness and in women with generalized thinning have also been seen. Many of us (hair transplant surgeons) have seen the negative effects of hair loss on self esteem and self-image.

We know that hair loss impacts some men sex life and their stability with regard to career choices in men of different ages. Despite the solid evidences and published literature on psychological impact of hair loss, the corrective effect of medical and surgical hair restoration has never been studied. After observing the drastic changes in patient behavior and the high level of patient satisfaction in those who had hair transplant procedure, we were motivated to look into the psychological impact of hair restoration on different aspects of a patient’s life.

We came up with a series of criteria that could have been modified by having a hair restoration procedure; we used some indexes that were previously studied comparing bald and non bald men on different psychological variables. We initially performed a pilot study and asked patients about different aspects of their lives during their post op visits. We gave our patients open ended questionnaires and probed their psychological state after their hair restoration procedure was complete. Eventually we focused in on eight major criteria that have been reported and documented as variables associated with hair loss in the literature. We collected a subset of them in our pilot study. Included were questions on the general level of happiness, energy level, feeling of youthfulness, anxiety levels, self confidence, outlook on their future and impact on their sex life.

We have chosen the patients who had their first hair transplant surgery between one to three years from the time of our study, so they had seen the final result of their hair restoration procedure. We limited the study to male patients with male pattern baldness and the ones who had surgeries less than three years ago so they still had a fresh memory of the changes they experienced. Each patient had exclusively follicular unit transplants that reflected our standard of care for that period. We sent a questionnaire with a brief description on the nature of this scientific study. We did not collect any patient identifiers and the response was totally voluntary. We sent the two hundred questionnaires with stamped return envelope.

The response rate to our questionnaire was 37 (18%). Each patient was used as his own control since we asked about the changes that they experienced after surgery in comparison to those variables before the surgery. We used T-test to compare patient’s responses. Table 1 shows the mean and standard error in eight different criteria that were asked. Patients had significant improvements in all eight criteria regardless of their stage of baldness and their ages.

In another attempt to compare psychological changes that patients experienced in different stages of baldness, we divided patients into two groups: (1) those who had Norwood IV patterns or less and (2) the ones with Norwood V patterns and above. We observed the most significant difference in two categories, (a) sex life and (b) career experience. Patients with less balding had a greater impact on their sex life and career when compared to patients who had more advanced stages of hair loss. These changes were not age related.

Hair restoration surgery can affect many aspects of a patient’s life. Hair transplant can potentially reverse psycho-social problems associated with hair loss. The positive impact of hair restoration surgery is more visible among patients who suffer from those undesirable effects the most. In early stages of hair loss, patients may have more awareness of their condition and they might be more affected than men in the later stages of hair loss.

Patients who experienced hair loss at an early age while involved in an active social life were more prone to the negative side effects of balding. That could explain why younger people with hair loss appeared more benefited by hair restoration procedures. Also it could be assumed that hair loss can have a negative impact on a patient’s outlook which seems to reverse after receiving a hair restoration procedure which improved their outlook.

Low response rate from a blind mailing has always been a drawback in questionnaire studies. We received 37 out of 200 of the questionnaires that we sent out (response rate was 18.5%). Giving incentives to responders may be a good way of increasing the participation rate of any questionnaire studies. We presented the result of this study at the annual scientific meeting of ISHRS and have been contacted by many of our colleagues who expressed interest in collaborating in a larger scale study. We are currently trying to rise funding for repeating this study to optimize our response rate and the statistical value of the study.

If you have any questions on the content of this article you can contact US Hair Restoration office at Los Angeles through email at info@ushairrestoration or phone.

Question:

Dear Dr. Mohebi,

Dr., I had a question: say I would use proscar now and took it for a while, after how long based on studies is it possible to see adverse side effects, if any? The reason why I ask is because when I went and read the messages on the forums, I saw positive and negative feedbacks. One person used proscar for 7 years and saw nothing but great results. I would like to give it a shot and see if I am lucky, hopefully. Thank you! Have a great weekend,

Answer:
The side effects of finasteride (Propecia/Proscar) could be seen anytime from right after starting it to months after starting finasteride. If you read the articles on adverse effects of finasteride you can clearly see that there is a small difference between the rates of side effects from the people who took placebos to the ones taking finasteride.

Let’s face it; you are prescribing a drug to a patient telling him that it works through altering your male hormones. What do you think the chances are that the patient will have problems with his sex drive?

The good news is that the side effects of finasteride are few and the most problematic one (decreased sex drive) is only seen in one out of a hundred patients. The other good news is that even if you are in that one percent category and you decide to continue using finasteride anyway, after one year of using finasteride the rate of side effects decreases to about the rate that was shown in people who only took a placebo.

I saw an 18 year old patient today who was worried about the recession of his hairline. We mapped his scalp hair to analyze the degree of miniaturization using a digital microscope. Here are pictures from the microscopic of his donor hair (left) vs. very frontal hairline (right).

Healthy donor hair (left) vs. significant miniaturization in hairline (right)

You can see significant miniaturization in the frontal area. When we examined a few centimeters behind his frontal hairline the miniaturization rate dropped sharply to less than 20% which was consistent throughout the top and crown area of the scalp. The patient’s father lost his hair at an early age. Patient started taking finasteride a month before his visit with us and topical Rogaine about a week before this visit.

What we observed was the maturation of his hair line, which occurs between the ages of 16-25 in most men. Hair line maturation is when the hair line migrates 1 to 2 cm higher than its normal position as when we are child (kiddy hairline). It is more significant in the corners but could be seen in the midline too. As Caucasian men go through the maturation process, the hairline rises, but many non-Caucasian men never experience hair line maturation and the hairline stays flat and low.

The best way to distinguish the maturation of the hairline from the early stages of baldness is by comparing miniaturization in different scalp areas. If you are experiencing early hair loss, your miniaturization could be seen behind the first centimeter of the frontal hairline, but if the rate of miniaturization drops sharply it could indicate that the hair line is going through maturation and the hair loss may stop shortly after maturation is complete.

We stopped all anti hair loss medications that the patient recently started, and we recommended another miniaturization study in 6 months to a year to follow his hair loss progression.

Dihydrotestosterone (DHT) is a byproduct of the hormone testosterone, formed primarily in the prostate gland and hair follicle cells. Hair follicles contain DHT receptors. Over time as males produce more and more DHT, the DHT molecules cause hair follicles to miniaturize and eventually fall out permanently in people who are genetically prone to baldness. In other words, some males have more hair follicles with these receptors than others.

DHT is the primary contributing factor in male pattern baldness. Unlike men with male-pattern baldness, women with female-pattern baldness are usually not characterized by increased production rates of DHT. Women with increased levels of DHT may develop certain male secondary sex characteristics, including a deepened voice and facial hair. Hair in the Crown and top of the head are usually loaded with these receptors in men with male pattern baldness. But the hair on the sides and the back, termed the permanent zone or donor area, are not affected by DHT. This allows us to transplant hair from the donor area into the frontal area without fear of it falling.

The transplanted hairs keep their resistance to DHT after hair transplant. Propecia is a drug that decrease the production of DHT by blocking the enzyme 5-alpha reductase that converts testosterone to DHT. This is how Propecia is effective in treating hair loss. Hair loss patients will decrease levels of DHT when they are on Propecia and this will help maintain and un-miniaturize hair follicles or even increase the size of hair shaft within the first year of using them.

It all has to do with the gene of male pattern baldness and being a man (having testosterone). I call it triangle of baldness. This triangle has three sides: